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Diseases 1, general

疾病1，全身 〔疾病1，全身〕jí bìng 1, quán shēn

Externally Contracted Febrile Diseases

Externally contracted febrile diseases (外感热病 wài gǎn rè bìng): Often just called external contractions. Diseases that in most cases begin swiftly when external evils invade the exterior and give rise to heat effusion (fever) together with aversion to cold. They include what we nowadays call colds and flu but also include more severe afflictions such as encephalitis, which begin with flu-like symptoms.

Externally contracted febrile disease is a term used in modern literature to denote diseases traditionally discussed in cold damage and warm disease theories. These are large and complex bodies of knowledge that are studied in detail after the basic theory of Chinese medicine has been mastered. What follows here is a brief description.

When external evils invade the body’s exterior, the body reacts by fighting them with its right qì, the forces of resistance. The struggle produces heat effusion. External evils depress the warming effect of defense yáng, so they cause aversion to cold. They also disrupt defense qì’s control over the interstices so that there is more sweating or absence of sweating. Heat effusion and aversion to cold are the two principal signs of initial-stage externally contracted disease manifesting in exterior patterns.

Very often, external evils that have invaded the body’s exterior causing cold and flu are successfully resisted by right qì and resolve within a few days. When right qì fails to resist them, they can pass into the interior, causing more severe conditions. As they penetrate the body, they undergo change. For instance, when wind-cold enters the interior, it often transforms into heat, giving rise to high fever and sometimes constipation (repletion heat patterns). If this heat damages right qì and burns itself out, the repletion heat pattern can give way to a vacuity cold pattern.

Cold damage (伤寒 shāng hán), in the broad sense, is externally contracted disease in the system devised by Zhāng Jī of the Hàn Dynasty to explain and treat them. According to cold damage theory, the external evils wind and more importantly cold invade the body and can affect different channels.

Usually, the evils first enter the exterior, affecting the greater yáng (tài yáng) channel, which governs the exterior. This manifests in aversion to cold and heat effusion. A distinction is made between wind strike (中风 zhòng fēng) and cold damage (伤寒 shāng hán, in the narrow sense of the term) depending on the presence or absence of sweating.

The external evils can also transform into heat and pass into the exterior to affect the yáng brightness (yáng míng) channel and give rise to interior heat patterns marked by high fever and in some cases constipation.

In some cases, the evil can affect the lesser yáng (shào yáng) channel, causing alternating aversion to cold and heat effusion, dizziness, bitter taste in the mouth, and dry throat. Lesser yáng (shào yáng) patterns are understood to be half exterior half interior, mid-stage between exterior and interior.

Much less commonly, the evils can also enter the yīn channels, mostly causing interior cold patterns. For example, when the evil enters the greater yīn (tài yīn), which is related to the spleen, there may be signs such as abdominal fullness, vomiting, and diarrhea.

Warm disease (温病 wēn bìng) is externally contracted disease in the system that developed in the early Qīng Dynasty, which explains such diseases as being principally caused by warm evil (heat evil), wind, and dampness. They are characterized by a tendency toward dryness formation and damage to yīn. Warm disease theory developed as a rival to cold damage theory, probably in response to changes in the nature of externally contracted febrile diseases brought about by changes in climate, the growth of populations in the south, and higher population concentrations in general.

Although the doctrine identifies many different diseases, the major classifications are wind warmth, damp warmth, and warm-heat.

Like cold damage theory, the warm disease doctrine posits a progression of disease through the body. Two alternative systems exist. According to one, the evil progresses through four aspects of the body: defense, qì, provisioning, and blood. The severity of the disease gains with the advance of the evil. According to the other system, progression occurs through the triple burner, starting with the upper burner and advancing to the lower burner.

Common cold (感冒 gǎn mào): Disease of sudden onset marked by lung signs such as cough, runny nose, sneezing, and by exterior signs (aversion to cold, heat effusion). Common cold is the most common type of external contraction. In modern texts, it is usually described as taking the form of wind-cold fettering the lung or wind-heat invading the lung. However, it can be analyzed more rigorously using the cold damage and warm disease schemes.

Malarial disease (疟疾 nüè jí): Also called torment disease (derived from虐 nüè, torment). A recurrent disease that manifests in aversion to cold with shivering, vigorous heat effusion, and sweating occurring in regular episodes (once a day to once every three days). The terms malarial disease and torment disease are preferred to malaria, since the diagnosis is based on symptoms, which may or may not correspond to the biomedical criteria of malaria. It is attributed to contraction of summerheat, contact with mountain forest miasma, or contraction of cold-damp. Several types are identified according to signs:

See also the following:

In the treatment of this disease, a common method is interrupting malaria (截疟 jié nüè), whereby treatment is applied two to three hours before an expected episode to prevent its arrival. The treatment makes use of medicinals such as cháng shān (Dichroae Radix), bīng láng (Arecae Semen), cǎo guǒ (Tsaoko Fructus), and jiāng bàn xià (Pinelliae Rhizoma cum Zingibere Praeparatum). In acupuncture, points such as GV‑14 (dà zhuī), SI‑3 (hòu xī), and PC‑5 (jiān shí) are drained.

Measles (麻疹 má zhěn): An epidemic disease affecting mostly children below the age of puberty, characterized by the eruption of papules the shape of sesame seeds. It is caused by contraction of seasonal pestilential heat toxin and mostly occurs at the end of winter or beginning of spring. The disease is located in the spleen and lung channels and can affect the other bowels and viscera.

Measles starts like a common cold, with cough, sneezing, runny nose with clear snivel, tearing, and heat effusion. After 2–3 days, a rash appears on the buccal mucosa (on the inside of the cheek). After 3–4 days, the rash spreads. It is peach pink in color, in the form of papules shaped like sesame seeds. On the outside of the body, it starts on the hairline behind the ears, gradually spreading to the forehead, trunk, and limbs.

Mumps (痄腮 zhà sāi): Also called massive head scourge (大头瘟 dà tóu wēn) or toad head scourge (虾蟆瘟 há má wēn) because the neck and head resemble those of a toad. An epidemic disease most prevalent in children in winter and spring, attributed to warm toxin, and marked by diffuse painful swelling in front of the ears (now known to be swelling of the parotid glands). The wind warmth toxin evil causes accumulation of heat in the stomach and intestines and depressed liver-gallbladder fire that obstructs the lesser yáng (shào yáng).

Wind papules (风疹 fēng zhěn): Also known as rubella (German measles). A disease manifesting in the form of a pale-red rash composed of small, densely distributed papules associated with itching. It is attributed to external contraction of wind evil.

Summer infixation (疰夏 zhù xià): The regular summer recurrence of loss of appetite, fatigue and lack of strength, and low fever with gradual recovery in the autumn (the driest season), occurring with sloppy stool or diarrhea. This is one form of dampness obstruction (dampness encumbering the spleen and stomach). A higher body temperature with more pronounced heat signs indicates summer heat-damp. Summer infixation is little discussed in modern literature, but it is a condition that is popularly recognized in China.

Smallpox (天花 tiān huā): An epidemic disease marked by heat effusion, cough, sneezing, yawning, red face, fright palpitation, cold extremities and ears, and the eruption of pox (a pustular eruption). Interestingly, historical records suggest that inoculation against smallpox was practiced as early as the Northern Sòng and that nasal inoculation was discovered in the Míng Dynasty between 1567 and 1572.

Tetany (痉 jìng): A class of diseases characterized by severe spasm, such as rigidity of the neck and nape, clenched jaw, convulsions, and arched-back rigidity (stiff back arched backward). Tetany notably includes lockjaw. In infants, it is called fright wind.

Lockjaw (破伤风 pò shāng fēng): Lockjaw (tetanus) is a disease marked by stiff nape, facial grimace, convulsions, arched-back rigidity, upward-staring eyes, and heat effusion and aversion to cold, arising when a virulent form of external wind, called wind toxin invades the body through a wound in the skin. Lockjaw in neonates is called umbilical wind.

Internal Damage and Miscellaneous Diseases

Wind stroke (中风 zhòng fēng): A disease characterized by the sudden development of deviated eyes and mouth, inhibited speech, and hemiplegia, sometimes heralded by sudden collapse and loss of consciousness, from which recovery may not be total.

Biomedical correspondence: The classical form corresponds to what we call stroke (apoplexy, cerebrovascular accident in biomedicine). Mild forms with only deviation of the eyes and mouth correspond to facial paralysis (Bell’s palsy) in biomedicine.

Originally ascribed to externally contracted wind evil, wind stroke was later attributed in many cases to internal causes, primarily liver wind stirring internally, which arises most commonly from insufficiency of kidney and liver yīn failing to keep liver yáng in check and hyperactive liver yáng transforming into wind. Phlegm is invariably a factor in wind stroke too, so the cause of the disease is often described as wind-phlegm.

In modern clinical practice, a broad twofold distinction is made:

Dispersion-thirst (消渴 xiāo kě): A disease characterized by thirst, increased fluid intake, and copious urine; attributed to disturbances mainly of the spleen-stomach and kidney. Dispersion-thirst is categorized as upper-, center-, and lower-burner dispersion depending on focus among the three burners.

Biomedical correspondence: diabetes mellitus, diabetes insipidus, and hypoadrenocorticism. A traditional threefold distinction is made, although modern internal medicine textbooks make finer differentiations.

Vacuity taxation (虚劳 xū láo): Any pattern of severe chronic vacuity. In older texts, vacuity taxation patterns complicated by external contractions are called wind taxation (风劳 fēng láo).

Depression patterns (郁证 yù zhèng): Disease patterns reflecting impairment of qì dynamic (deficient free coursing) that stems from affect-mind disturbances (emotional problems). They mostly involve binding depressed liver qì and disturbance of the heart spirit but also feature other factors such as dampness, phlegm, and blood stasis, which often foster or are fostered by depressed liver qì. They are marked by affect-mind signs as well as physical signs:

Depression patterns are not entirely distinct from mania and withdrawal disease and can easily develop into it. However, their key distinguishing feature is that the spirit-mind is clear: patients retain normal mental faculties.

Epilepsy (癫痫 diān xián): A disease characterized by brief episodes (seizures) marked by spasm and temporary loss of spirit.

The convulsions are explained by internal wind, while the loss of consciousness is explained by the wind carrying phlegm upward to cloud the heart spirit. The term fright epilepsy, which is commonly seen in traditional literature, refers to epileptic fits triggered by fright or emotional shock.

Mania and withdrawal (癫狂 diān kuáng): Mania and withdrawal is a generic term for all conditions marked by mental derangement manifesting in disorganized behavior and speech and inability to cope with the demands of everyday life.

Mania (狂 kuáng) is characterized by manic agitation, shouting, violent behavior, and abusive speech. It is mostly attributable to phlegm-fire harassing the spirit or exuberant fire damaging yīn.

Withdrawal (癫 diān) is marked by signs such as mental depression, taciturnity, talking to self (soliloquy), and feeble-mindedness. It is mostly attributable to binding depression of phlegm and qì or to dual vacuity of the heart and spleen.

Mania and withdrawal are not entirely distinct. In enduring withdrawal, depressed phlegm can transform into fire, causing mania. In prolonged mania, depressed fire can diffuse and discharge to leave stagnant phlegm and qì, causing withdrawal.

The term mania and withdrawal is a generic term for different types of mental illness. Although it is reminiscent of manic depression, it denotes a far wider range of conditions than just bipolar disorder. It includes depression, manic depression, schizophrenia, and delusional disorders.

Feeble-mindedness (痴呆 chī dāi): Dementia; a condition manifesting in dull facial expression, indifference of spirit-affect, dull reactions, and strange behavior. It is caused by congenital insufficiency, or by phlegm turbidity clouding the heart, which arises through such factors as depressed liver qì and spleen-stomach vacuity. Feeble-mindedness is poorly distinguishable from withdrawal in mania and withdrawal disease (癫狂 diān kuáng).

Inferiority-timidity (卑惵 bēi dié): A traditionally recognized spirit abnormality characterized by shame, guilt, and feelings of inferiority, often associated with a slender body, poor appetite, and scantness of qì.

Visceral agitation (脏躁 zàng zào): A traditionally recognized episodic spirit abnormality in women heralded by melancholy, depression, emotionalism, and increased or diminished sensitivity. Attacks are characterized by vexation and oppression, impatience and agitation, sighing for no apparent reason, and sadness with a desire to weep. It is attributed to the heart spirit deprived of nourishment, often as a result of dual vacuity of the heart and spleen or to insufficiency of the liver and kidney.

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